| NPI | 1205039005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL LMHC9123) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP 9292654) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL RN9292654) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP 9292654) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2023-11-08 |